Clozapine in the Elderly and Those with Medical Comorbidity, and Care Transitions-Presentation Slides

Presentation Slides

Pdf Summary

The document discusses the use of clozapine in elderly patients with schizophrenia and medical comorbidity, as well as the management of care transitions. It highlights that elderly patients can be safely started on clozapine and outlines common principles for treating those at higher risk for adverse events, such as adjusting titrations and minimizing drug interactions. The document also addresses concerns specific to the elderly population, including reduced serum albumin levels, increased volume of distribution, and age-related decline in CYP 1A2 activity.<br /><br />Retrospective data is presented showing that clozapine is well tolerated in elderly patients and can lead to lower psychiatric hospitalization rates. The document also discusses clozapine dosing in the elderly, noting that median doses are lower compared to younger patients and the ratio of clozapine to norclozapine is higher.<br /><br />The document emphasizes the importance of managing clozapine titration in the elderly, taking into account kinetic and pharmacodynamic drug-drug interactions, and the need to aggressively manage constipation. It also discusses the effects of CYP inhibitors and inducers on clozapine levels and provides a list of common inhibitors and inducers.<br /><br />Furthermore, the document addresses the prevention of ileus, minimizing orthostasis and sedation, and the rechallenge of high-risk patients. It provides recommendations for managing anticholinergic medications and other constipating medications. Additionally, it discusses the approach to rechallenging patients with a history of seizures, diabetic ketoacidosis, myocarditis, cardiomyopathy, priapism, venous thromboembolism, and laboratory abnormalities.<br /><br />The document concludes by highlighting the importance of improving acceptance of clozapine and effective communication during care transitions. It suggests discussing the benefits of clozapine treatment, using finger-stick POC devices for ANC monitoring, and not removing prior antipsychotics too quickly. Finally, it emphasizes that elderly patients should not be deprived of a clozapine trial based on age and that adjustments in dosing and medication management are necessary.

Keywords

clozapine

elderly patients

schizophrenia

medical comorbidity

care transitions

adverse events

titrations

drug interactions

psychiatric hospitalization rates

dosing